Materiały źródłowe

• #1 Hypospadias – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypospadias/diagnosis-treatment/drc-20355153

  Your child’s pediatrician can diagnose hypospadias based on a physical exam. You’ll likely be referred to a surgeon who specializes in genital and urinary conditions, called a pediatric urologist, for more evaluation. Medical centers with specialty teams can help you look at treatment options and can provide expert treatment. […] Most often, babies with hypospadias are diagnosed while still in the hospital after birth. If your baby has hypospadias, you’ll likely be referred to a pediatric urologist. Here’s some information to help you get ready for your appointment.

• #2 Hypospadias: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15060-hypospadias

  Hypospadias is a congenital condition in which the meatus isnt at the tip of the penis. A provider can diagnose it shortly after birth. Hypospadias usually requires surgery. […] Healthcare providers usually diagnose hypospadias shortly after birth. Checking for hypospadias is part of the routine newborn physical examination that a pediatrician performs. […] If a pediatrician detects hypospadias, theyll refer you to a pediatric urologist. A pediatric urologist is a doctor who specializes in diagnosing and treating conditions that affect the urinary and reproductive systems in children. […] Surgery (hypospadias repair) can treat hypospadias. Most pediatric urologists will perform a hypospadias repair when your child is between 6 and 12 months old. […] The outlook for hypospadias is good. Hypospadias repair has a high success rate. The goal of successful surgery is to create a penis that appears and functions normally.

• #3 Hypospadias in Children: Diagnosis and Treatment

  https://www.massgeneral.org/children/hypospadias/diagnosis-and-treatment

  If the hypospadias is severe, doctors may diagnose it prenatally (before birth) through an ultrasound. However, it is more common for a family member or doctor to notice the condition after your baby is born. This is because the penis may look unusual. A pediatric urologist or pediatric surgeon can diagnosis hypospadias with a physical examination. […] Hypospadias surgery is best performed between 6 months of age and 3 years of age (before your child is toilet trained). This is when the risks of psychologically stressing your child and of using general anesthesia are both low. […] While boys rarely experience complications following hypospadias surgery, problems are more likely to happen following a proximal hypospadias correction. Infection and bleeding are rare, and the most common problem following surgery is a hole (fistula) that forms in another place on the penis. Additionally, scars may form in the urethra that could interfere with urination. If your child experiences urine leaking from a second hole or a decreased urinary stream, call a pediatric urologist immediately.

• #4 Ultrasonographic Diagnosis of Fetal Hypospadias

  https://www.mdpi.com/2075-4418/12/4/774

  Fetal hypospadias should be consider in a male fetus with a shortened penis, blunt bulbous tips, ventrally curved shaft with or without chordee and a typical fan shape stream of urinary jet under color Doppler under prenatal ultrasound examination. The more severe form is usually accompanied by other congenital abnormalities. […] Hypospadias is characterized by an abnormal placement of the external urethral meatus in male infants usually accompanied by ventrally bent penile shaft with dorsal hood of the prepuce. […] Although positive predictive value of prenatal diagnosis of hypospadias is reported to be 72%, it might be difficult, especially in those with first degree with meatus opening at the glanular or coronal, which need a color Doppler to detect the specific jet of the urinary stream.

• #5 Ultrasonographic Diagnosis of Fetal Hypospadias

  https://www.mdpi.com/2075-4418/12/4/774

  Prenatal diagnosis is generally made in the third trimester in early reports with the advance of sonographic technique, it is possible to confirming the diagnosis during the early second trimester with the advance of ultrasound technique. Most prenatally diagnosed cases have been attributed to distal hypospadias with ultrasound findings of anomalous distal morphology of the penis, small lateral folds, small penis with ventral incurvation or an anomalous urinary stream. […] The normal penile shaft has a smooth tapering pointed tip appearance. In hypospadias, the tip of the penis is blunted and bulbous with two echogenic lines corresponding to small lateral folds belonging to the dermal remains of the prepuce (dorsal hood) these are usually the first signs for a suspicious hypospadias. […] Observing the flow of urine can aid in the diagnosis and in establishing the degree/severity of the condition. Fetal micturition occurring proximal to the glans may be demonstrated on gray scale or color Doppler images. The stream is often fan-shaped and not linear with ventral deflection of the urinary stream jet always observed as seen in our cases. Most antenatal screening of fetal hypospadias could be carried out after 20 weeks of gestational age with color Doppler showing the fanning of urinary stream as a confirmatory tool in fetus with short and blunt penis. Additional searching for other anomalies and karyotyping should be consider for further evaluation.

• #6 Prenatal diagnosis of hypospadias with 2-dimensional and 3-dimensional ultrasonography | Scientific Reports

  https://www.nature.com/articles/s41598-019-45221-z

  To compare the prenatal diagnostic performance as well as appearance of ultrasonic details between 2-dimensional ultrasonography (2DUS) combined with 3-dimensional ultrasonography (3DUS) and 2DUS alone for hypospadias. […] Overall 2DUS combined with 3DUS showed a trend toward higher performance compared with 2DUS alone for the diagnosis of hypospadias, although the difference was not statistically significant. 3DUS is a useful complement for 2DUS in the diagnosis of fetal hypospadias and may provide more detailed information related to its diagnosis and prognosis. […] The agreement for the diagnosis of hypospadias between the two methods was moderate [kappa=0.592]. […] The AUC values of 2DUS in combination with 3DUS and 2DUS alone were 0.85 (95% CI, 0.740.96) and 0.76 (95% CI, 0.630.89), respectively, with no significant difference between the two modalities (p=0.08).

• #7 Prenatal diagnosis of hypospadias with 2-dimensional and 3-dimensional ultrasonography | Scientific Reports

  https://www.nature.com/articles/s41598-019-45221-z

  In conclusion, 2DUS combined with 3DUS showed a trend toward higher performance compared with 2DUS alone for the diagnosis of hypospadias, although the difference was not statistically significant. 3DUS is a useful complement for 2DUS in the diagnosis of fetal hypospadias and may provide more detailed information related to its diagnosis and prognosis.

• #8 Hypospadias: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15060-hypospadias

  Hypospadias is a congenital condition in which the meatus isnt at the tip of the penis. A provider can diagnose it shortly after birth. Hypospadias usually requires surgery. […] Healthcare providers usually diagnose hypospadias shortly after birth. Checking for hypospadias is part of the routine newborn physical examination that a pediatrician performs. […] If a pediatrician detects hypospadias, theyll refer you to a pediatric urologist. A pediatric urologist is a doctor who specializes in diagnosing and treating conditions that affect the urinary and reproductive systems in children. […] Surgery (hypospadias repair) can treat hypospadias. Most pediatric urologists will perform a hypospadias repair when your child is between 6 and 12 months old. […] The outlook for hypospadias is good. Hypospadias repair has a high success rate. The goal of successful surgery is to create a penis that appears and functions normally.

• #9 Hypospadias – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypospadias/symptoms-causes/syc-20355148

  Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip. […] Most babies with hypospadias are diagnosed soon after birth while still in the hospital. […] Talk with your doctor or other healthcare professional if you have concerns about the look of your child’s penis or if your child has problems passing urine. […] Hypospadias is a condition that is present at birth. […] In most cases, the exact cause of hypospadias is not known. […] If hypospadias is not treated, it can result in differences in how the penis looks. […] Problems learning to use a toilet. […] Unusual curve of the penis with an erection. […] Problems releasing sperm from the penis.

• #10 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The initial diagnosis of hypospadias is typically made after birth during physical exam, where boys with hypospadias are found to have a ventral skin deficiency with a dorsal hood of foreskin and an abnormally located meatus with varying degrees of ventral penile curvature. […] The standard classification of hypospadias is based on location of the urethral meatus: distal, midshaft, or proximal. […] In cases of proximal hypospadias associated with unilateral or bilateral non-palpable cryptorchidism, disorders of sexual differentiation are noted in 17-29% of patients. Therefore, initial evaluation should include serum electrolytes, 17-hydroxyprogesterone (17-OHP), karyotype, abdominal ultrasound to assess for Mullerian structures, and endocrine referral. […] The surgical management of hypospadias aims to achieve: A straight penis with a slit-shaped and adequate caliber meatus at the apex of the glans, A conical reconfigured glans, Either a circumcised appearance of the penis or if the parents opt for preputial reconstruction, a foreskin that is complete circumferentially and easily retractable, An acceptable cosmetic outcome judged objectively.

• #11 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The multiple surgical options available for hypospadias repair are a testament to the fact that no surgical procedure guarantees universal success by all surgeons. […] The position of the meatus is not the sole determinant of the difficulty in reconstruction. […] Therefore, all hypospadias surgery should preferably be performed by a competent hypospadiologist, who ideally has an annual hypospadias surgical volume of 40-50 cases. […] The physical examination of a child with hypospadias yields key information that allows operative planning. […] Preoperative androgen stimulation in the form of systemic testosterone, topical testosterone, and derivatives like dihydrotestosterone (DHT) and human chorionic gonadotropin (hCG) have been used to stimulate glans size preoperatively to allow better tubularization of the urethral plate and decrease the incidence of glans dehiscence.

• #12 Hypospadias – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypospadias/diagnosis-treatment/drc-20355153

  Your child’s pediatrician can diagnose hypospadias based on a physical exam. You’ll likely be referred to a surgeon who specializes in genital and urinary conditions, called a pediatric urologist, for more evaluation. Medical centers with specialty teams can help you look at treatment options and can provide expert treatment. […] Most often, babies with hypospadias are diagnosed while still in the hospital after birth. If your baby has hypospadias, you’ll likely be referred to a pediatric urologist. Here’s some information to help you get ready for your appointment.

• #13 Diagnosing Hypospadias in Children | NYU Langone Health

  https://nyulangone.org/conditions/hypospadias-in-children/diagnosis

  Every year, an estimated 1 in 125 American boys is born with hypospadias. […] Hypospadias develops during pregnancy, at 8 to 14 weeks, and can cause a misdirected urinary stream, making it difficult to stand to urinate. […] Your babys pediatrician always examines your newborn soon after birth. If the opening of his urethra isnt located at the tip of the penis, the pediatrician calls a urologist who specializes in hypospadias to perform a physical exam. […] Depending on the location of the urethras opening and the extent of any curvature of the penis, doctors at Hassenfeld Childrens Hospital at NYU Langone determine if surgery is needed. […] Infants who have hypospadias shouldnt be circumcised, because the foreskin may be needed during the reconstruction of the urethra.

• #14 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The initial diagnosis of hypospadias is typically made after birth during physical exam, where boys with hypospadias are found to have a ventral skin deficiency with a dorsal hood of foreskin and an abnormally located meatus with varying degrees of ventral penile curvature. […] The standard classification of hypospadias is based on location of the urethral meatus: distal, midshaft, or proximal. […] In cases of proximal hypospadias associated with unilateral or bilateral non-palpable cryptorchidism, disorders of sexual differentiation are noted in 17-29% of patients. Therefore, initial evaluation should include serum electrolytes, 17-hydroxyprogesterone (17-OHP), karyotype, abdominal ultrasound to assess for Mullerian structures, and endocrine referral. […] The surgical management of hypospadias aims to achieve: A straight penis with a slit-shaped and adequate caliber meatus at the apex of the glans, A conical reconfigured glans, Either a circumcised appearance of the penis or if the parents opt for preputial reconstruction, a foreskin that is complete circumferentially and easily retractable, An acceptable cosmetic outcome judged objectively.

• #15 Hypospadias: Causes, Diagnosis and Treatment

  https://www.urology-textbook.com/hypospadias.html

  Hypospadias is a common congenital disease of the penis with an abnormal ventral opening of the meatus of the urethra, a deficient ventral prepuce (dorsal hood) and an uretral plate reaching from meatus to the tip of the glans (chordee). […] The classification of hypospadias depends on the position of the urethral meatus: Glanular, Coronal, Penile (distal-middle-proximal), Scrotal, Perineal. […] The incidence of hypospadias is increasing. […] In addition to a exact documentation of the findings (position of the meatus, penile length, configuration of the prepuce and scrotum, position of the testes), ultrasound imaging of the urinary organs is advised. […] Disorders of sex development are more prevalent in patients with proximal hypospadias, the following evaluations are necessary: Family history, Karyotyping, Hormone analysis, Pelvic ultrasound imaging, MRI and/or retrograde genitography, Micturition cystourethrogram, Cystoscopy. […] Further diagnostics and referral to a DSD center may be appropriate depending on the findings.

• #16 Hypospadias – Birth Defect Fact Sheet

  https://birthdefects.org/hypospadias/

  Hypospadias is a congenital abnormality of the penis in which the urinary tract opening is not at the tip. In boys with hypospadias, the urine tube is short and does not come out to the end of the penis. Fortunately, 90% of hypospadias cases are minor with the urethral opening on or just below the head of the penis. […] Forms of Hypospadias in which the urethral opening is located on the penile shaft or in the perineum may interfere with normal urination and fertility. […] Hypospadias can be familial, although the exact mechanism by which it is inherited is not known. […] Hypospadias is usually obvious at birth. At times, Hypospadias can be diagnosed from a prenatal ultrasound examination. […] Not every child with Hypospadias requires surgery, but in most cases certain functions may not be possible unless the problem is corrected. […] The ideal age for repair is usually before the age of eighteen months. […] Results of Hypospadias surgery are good. Overall, greater than 90% of boys with Hypospadias will have the condition corrected in a single operation.

• #17 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The initial diagnosis of hypospadias is typically made after birth during physical exam, where boys with hypospadias are found to have a ventral skin deficiency with a dorsal hood of foreskin and an abnormally located meatus with varying degrees of ventral penile curvature. […] The standard classification of hypospadias is based on location of the urethral meatus: distal, midshaft, or proximal. […] In cases of proximal hypospadias associated with unilateral or bilateral non-palpable cryptorchidism, disorders of sexual differentiation are noted in 17-29% of patients. Therefore, initial evaluation should include serum electrolytes, 17-hydroxyprogesterone (17-OHP), karyotype, abdominal ultrasound to assess for Mullerian structures, and endocrine referral. […] The surgical management of hypospadias aims to achieve: A straight penis with a slit-shaped and adequate caliber meatus at the apex of the glans, A conical reconfigured glans, Either a circumcised appearance of the penis or if the parents opt for preputial reconstruction, a foreskin that is complete circumferentially and easily retractable, An acceptable cosmetic outcome judged objectively.

• #18 Proximal Hypospadias: More Than Meets the Eye? – American Urological Association

  https://auanews.net/issues/articles/2022/january-2022/proximal-hypospadias-more-than-meets-the-eye

  Hypospadias is a congenital genital abnormality that affects ~1/300 live male births. Proximal hypospadias is the most severe form and involves the urethral opening in a penoscrotal or perineal location. Boys with proximal hypospadias frequently also have significant ventral chordee (penile curvature) and may have associated scrotal abnormalities and/or undescended testes. The significance and recommended work-up for patients with proximal hypospadias are debated among pediatric urologists, largely due to the social and medicolegal implications of labeling proximal hypospadias a “difference/disorder of sex development” (DSD). […] While proximal hypospadias can be an isolated genital condition, boys are at increased risk for genetic diagnoses (DSD and others) and multisystem comorbidities. The genetic diagnoses found can affect clinical prognosis, medical screening recommendations and surgical counseling.

• #19 Hypospadias Differential Diagnoses

  https://emedicine.medscape.com/article/1015227-differential

  In 1981, Khuri et al reviewed more than 1000 patients with hypospadias and reported that the incidence of undescended testes and inguinal hernias was 9% for each. With more severe forms of hypospadias, the incidence of undescended testes exceeded 30%, and the incidence of inguinal hernias approached 20%. It is important to evaluate the position of the testes and assess for the presence of inguinal hernia as part of the physical examination for hypospadias. […] The combination of hypospadias and undescended testis can be an indicator of an underlying difference (disorder) of sex development (DSD). In a 1999 study by Kaefer et al, DSD states were identified in approximately 30% of patients with unilateral or bilateral undescended testes and hypospadias, and a more proximal meatal location carried a higher association of DSD states than a more distal meatal location. If any gonad was nonpalpable, the incidence rose to 50%; however, if both gonads were palpable, the incidence was only 15%.

• #20 Hypospadias and undescended testis- Hypospadias Foundation

  https://www.hypospadiasfoundation.com/hypospadias-and-undescended-testis-diagnosis-surgery-and-treatment-plan/

  Hypospadias and undescended testis (also called cryptorchidism) are both very common clinical problems in young children. While hypospadias occurs in 1/150 boys, undescended testis is even more common. But the treatment for both of them is different. […] Hypospadias on the other side, almost always requires surgical correction. And the right age for doing the hypospadias surgery is between 6-18 months of age. We typically advise the hypospadias repair surgery to be scheduled around 9-10 months of age. […] When both hypospadias and undescended testis occur together, the diagnosis and treatment is much more complex. The most important thing to be done for these children is to investigate them for disorder of sex development or DSD. DSD is present in upto 15% of children who have both hypospadias and undescended testis.

• #21 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The initial diagnosis of hypospadias is typically made after birth during physical exam, where boys with hypospadias are found to have a ventral skin deficiency with a dorsal hood of foreskin and an abnormally located meatus with varying degrees of ventral penile curvature. […] The standard classification of hypospadias is based on location of the urethral meatus: distal, midshaft, or proximal. […] In cases of proximal hypospadias associated with unilateral or bilateral non-palpable cryptorchidism, disorders of sexual differentiation are noted in 17-29% of patients. Therefore, initial evaluation should include serum electrolytes, 17-hydroxyprogesterone (17-OHP), karyotype, abdominal ultrasound to assess for Mullerian structures, and endocrine referral. […] The surgical management of hypospadias aims to achieve: A straight penis with a slit-shaped and adequate caliber meatus at the apex of the glans, A conical reconfigured glans, Either a circumcised appearance of the penis or if the parents opt for preputial reconstruction, a foreskin that is complete circumferentially and easily retractable, An acceptable cosmetic outcome judged objectively.

• #22 Proximal Hypospadias: More Than Meets the Eye? – American Urological Association

  https://auanews.net/issues/articles/2022/january-2022/proximal-hypospadias-more-than-meets-the-eye

  Taken together, given high rates of DSD and genetic conditions in boys with proximal hypospadias, we recommend at minimum a karyotype in the initial diagnostic approach for these patients. It is prudent to pursue further genetic and endocrine evaluation in the setting of concomitant undescended testicle(s) or in the presence of multiple congenital anomalies. Further testing should be considered if scrotal abnormalities (eg bifid, penoscrotal transposition) are present. […] When evaluated with genetic and endocrine testing, many boys with proximal hypospadias are found to have DSD and other systemic genetic conditions that affect future care and prognosis. All boys with proximal hypospadias should have a karyotype. Further genetic and endocrine testing should be considered for boys with proximal hypospadias and undescended testes, multiple congenital anomalies, scrotal abnormalities, and families who desire more information.

• #23 Proximal Hypospadias: More Than Meets the Eye? – American Urological Association

  https://auanews.net/issues/articles/2022/january-2022/proximal-hypospadias-more-than-meets-the-eye

  Taken together, given high rates of DSD and genetic conditions in boys with proximal hypospadias, we recommend at minimum a karyotype in the initial diagnostic approach for these patients. It is prudent to pursue further genetic and endocrine evaluation in the setting of concomitant undescended testicle(s) or in the presence of multiple congenital anomalies. Further testing should be considered if scrotal abnormalities (eg bifid, penoscrotal transposition) are present. […] When evaluated with genetic and endocrine testing, many boys with proximal hypospadias are found to have DSD and other systemic genetic conditions that affect future care and prognosis. All boys with proximal hypospadias should have a karyotype. Further genetic and endocrine testing should be considered for boys with proximal hypospadias and undescended testes, multiple congenital anomalies, scrotal abnormalities, and families who desire more information.

• #24 Hypospadias Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/1015227-workup

  No laboratory tests have been found to be helpful in the evaluation and management of hypospadias. In cases where a difference (disorder) of sex development (DSD) is suspected, hormonal evaluation may be needed. […] Anomalies of the upper urinary tract are rarely associated with hypospadias and do not justify routine imaging in these patients unless other organ system anomalies are present. Other associated findings are more common (eg, enlarged prostatic utricle, low-grade vesicoureteral reflux [VUR]) but are of little consequence clinically unless other symptoms merit evaluation. […] It has been argued that prostatic utricles are an underappreciated cause of urologic morbidity and may present as penile pain with voiding, hematuria, epididymitis, and urinary tract infection (UTI) and therefore should be sought with retrograde urethrography in the setting of proximal hypospadias. […] In very rare instances, presence of meatal stenosis may prevent normal egress of urine and cause distal ballooning of the urethra. This may necessitate a temporizing meatoplasty to allow normal flow of urine.

• #25 Hypospadias

  https://caps.nationwidechildrens.org/radiology/atlas/Urethra_Atlas/Hypospadias.html

  Hypospadias is an abnormality in boys in which failure of closure of the urethral lumen leads to an abnormal ventral positioning of the urethral orifice. […] The diagnosis of hypospadias in usually evident on newborn physical examination though may not always be the case with milder forms. […] The literature does not support routine imaging of the urinary tract for evaluation of hypospadias, particularly when a minor or intermediate defect. VCUG is most commonly done in patients exhibiting an intermediate or extreme hypospadias, and in those requiring extensive urethroplasty.

• #26 Hypospadias: Comprehensive Overview, Diagnosis and Treatment

  https://www.instituteofurology.in/hypospadias-comprehensive-overview-diagnosis-and-treatment/

  Hypospadias is typically diagnosed through a physical examination at birth. The pediatrician or pediatric urologist will assess the location of the urethral meatus, the presence of chordee, and the overall appearance of the penis. In some cases, further evaluations may be necessary to determine the extent of the anomaly. […] While physical examination is often sufficient, imaging studies may be used in complex cases: Ultrasound: To evaluate associated urinary tract anomalies. Magnetic Resonance Imaging (MRI): Rarely used, but can provide detailed anatomical information in severe cases. […] In cases where hypospadias is part of a broader syndrome or associated with other abnormalities, genetic and hormonal testing may be indicated. This can help identify underlying conditions that may need to be addressed.

• #27 Hypospadias | Department of Urology

  https://www.med.unc.edu/urology/pediatrics/pediatric-conditions/hypospadias/

  Typically, infants are diagnosed with hypospadias soon after birth. […] If your child is diagnosed with hypospadias, a circumcision should not be performed because the foreskin tissue may be needed for repair. […] Sometimes, mild hypospadias may be overlooked. Occasionally, it is possible for a boy to have a normal foreskin that covers the hypospadias. If this occurs, hypospadias may be diagnosed after your child is circumcised. […] Surgery is required to reposition the urethral opening to the tip of the penis, if necessary straighten the shaft of the penis and correct or remove the dorsal hooded foreskin. […] In most cases, surgical repair results in a penis with a normal or near-normal function and appearance with no immediate or long-term problems.

• #28 Hypospadias: Overview, Diagnosis and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/hypospadias

  Most hypospadias will be recognized shortly after birth due to the appearance of the penis and foreskin. […] The abnormality may only be diagnosed after a neonatal circumcision is performed or later in life if the family chooses not to have the baby circumcised at birth. […] Newborns with hypospadias are usually seen by pediatric urologist within the first few months. […] Surgical repair of hypospadias is typically done between 6 to 12 months of age, depending on the health of the baby and any other medical issues. […] In more severe forms of hypospadias, more than one surgery may be necessary with increased risks and complications.

• #29 Hypospadias Diagnostic Evaluation Center for Reconstructive Urology

  https://centerforreconstructiveurology.org/hypospadias/hypospadias-diagnostic-evaluation/

  Hypospadias Diagnostic Evaluation […] When there has been no prior hypospadias treatment, the focus of the history is the presence or absence of symptoms suggestive of urethral stricture disease or downward curvature (chordee) with erections. The complete physical exam includes a careful assessment of the quality and redundancy of the penile skin, the appearance and location of the opening of the urethra relative to the tip of the penis, penile length, and the appearance of the scrotum. […] Infants and young children born with hypospadias often undergo hypospadias treatment with surgical repair without any testing to evaluate the urethra as urethral stricture disease is not generally present. However, untreated hypospadias is a risk factor for the development of urethral stricture disease in adults. Therefore, when adults present to the Center for Reconstructive Urology requesting hypospadias repair, we calibrate the urethral opening using instruments called Bougies.

• #30 Adult Hypospadias in Men | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/adult-hypospadias

  Hypospadias can be present for several years or last the duration of a patients life. […] Although hypospadias is often detected at birth, adults suffering from long-lasting effects of hypospadias can be diagnosed based on a physical examination performed by a healthcare provider.

• #31 Female Hypospadias and Urinary Incontinence: Surgical Solution of a Little-Known Entity

  https://www.clinmedjournals.org/articles/iauc/international-archives-of-urology-and-complications-iauc-4-049.php?jid=iauc

  Female hypospadias is a rare genito-urinary anomaly, often associated with other congenital malformations of the urinary tract. […] Even though commons symptoms related to female hypospadias include urinary incontinence, recurrent urinary tract infections and dyspareunia, patients are often diagnosed accidentally during catheterization for other reasons. […] Its detection is simple but often late in childhood or even in adulthood. Treatment can be difficult due to the lack of consistent literature on the topic and also because it requires management of the other associated anomalies. […] We describe the case of a 5-year-old girl presenting incontinence secondary to hypospadias, successfully treated with a 2-step surgical strategy. […] VCUG demonstrated resolution of the previously treated VUR with a lower bladder on the perineal plane, with the base projected constantly under the upper profile of the pubic symphysis; also, a short urethra, of regular calibre, was seen.

• #32 Female Hypospadias and Urinary Incontinence: Surgical Solution of a Little-Known Entity

  https://www.clinmedjournals.org/articles/iauc/international-archives-of-urology-and-complications-iauc-4-049.php?jid=iauc

  On physical examination under general anaesthesia before cystoscopy, a mega external urethral meatus opening over the superior vaginal wall could be evidently seen. […] At the end of the work-up, this patient’s incontinence was both a real incontinence determined by a short urethra on which the perineal muscular complex could not act at best and a pseudo-incontinence determined by ureteral ectopy but also by the hypospadias itself because of vaginal micturition. […] After careful analysis of the limited existent literature on the topic, we planned a 2/3 step program: A distal urethral lengthening through a periurethral vaginal flap urethroplasty in double layer, the ectopic ureter’s reimplantation and an eventual bladder neck reconstruction. […] The catheter was removed after a month. After the procedure the patient herself reported a substantial improvement in the quantity of involuntary urinary loss, thus proving an important role of female hypospadias regarding incontinence and pseudo-incontinence.

• #33 SPU – Female Hypospadias : Rare or missed diagnosis

  https://spuonline.org/meeting/abstracts/2020/P10.cgi

  Female hypospadias seems to have attracted less attention and many cases go undiagnosed as is evident from the literature that most of the reported cases are case reports only. […] This shows that diagnosis of the anomaly is missed. […] Catheterization and/ or cystoscopy clinched the diagnosis. […] The diagnosis of female hypospadias was made by catheterization, colposcopy, voiding cysto-urethrogram pandoscopy. […] High index of suspicion is required to diagnose hypospadias specially in patients presenting with abnormal urinary stream, vaginal discharge, urinary incontinence and UTI. […] Good outcome is expected by early diagnosis and management.

• #34 Hypospadias & Chordee | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/h/hypospadias-chordee

  Hypospadias is a common structural difference of the penis where the urethra (the tube that carries urine from the bladder to outside of the body) is on the underside rather than the tip of the penis. The opening can be located anywhere on the undersurface of the penis to the scrotum. […] Usually, hypospadias is noticed at birth. Along with the misplaced opening, the foreskin is often incomplete and forms a hood. This is called a dorsal hood. […] Some patients with hypospadias do not undergo any treatment besides observation, due to no symptoms or patient / family preference. Surgical treatment of hypospadias and chordee can change the appearance of the penis and is desired by some patient / families after discussion with their doctor. […] Surgery can often correct hypospadias. The care team may recommend surgery to: Bring the urethral opening to the tip of the penis. This allows a controlled stream of urine while standing. […] Hypospadias surgery may be very successful, but there can be some potential complications. In some cases, a hole or a fistula may occur, and urine may leak through the hole. More surgery may be needed to repair this problem.

• #35 Hypospadias – Wikipedia

  https://en.wikipedia.org/wiki/Hypospadias

  Where hypospadias is seen as a genital ambiguity in a child, the World Health Organization standard of care is to delay surgery until the child is old enough to participate in informed consent, unless emergency surgery is needed because the child lacks a urinary opening. […] Surgery can extend the urinary channel to the end of the penis, straighten bending, and/or change the foreskin (by either circumcision or by altering its appearance to look more typical („preputioplasty”), depending on the desire of the patient. […] Surgical repair of severe hypospadias may require multiple procedures and mucosal grafting. […] Patients and families considering surgery for hypospadias should have realistic expectations about the risks and benefits. […] The results of surgery are probably not influenced by the age at which repair is done.

• #36 Hypospadias repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003000.htm

  Hypospadias is one of the most common birth defects in boys. This surgery is performed on most boys who are born with the problem. […] If the repair is not done, problems may occur later on such as: […] Surgery is not needed if the condition does not affect normal urination while standing, sexual function, or the deposit of semen. […] Your child’s health care provider may ask for a complete medical history and do a physical exam before the procedure. […] Right after surgery, your child’s penis may be taped to his belly so that it does not move. […] This surgery lasts a lifetime. Most children do well after this surgery. The penis will look almost or completely normal and function well. […] Follow-up visits with a urologist may be needed after the surgery has healed. Boys will sometimes need to visit the urologist when they reach puberty.

• #37 Hypospadias in Children: Diagnosis and Treatment

  https://www.massgeneral.org/children/hypospadias/diagnosis-and-treatment

  If the hypospadias is severe, doctors may diagnose it prenatally (before birth) through an ultrasound. However, it is more common for a family member or doctor to notice the condition after your baby is born. This is because the penis may look unusual. A pediatric urologist or pediatric surgeon can diagnosis hypospadias with a physical examination. […] Hypospadias surgery is best performed between 6 months of age and 3 years of age (before your child is toilet trained). This is when the risks of psychologically stressing your child and of using general anesthesia are both low. […] While boys rarely experience complications following hypospadias surgery, problems are more likely to happen following a proximal hypospadias correction. Infection and bleeding are rare, and the most common problem following surgery is a hole (fistula) that forms in another place on the penis. Additionally, scars may form in the urethra that could interfere with urination. If your child experiences urine leaking from a second hole or a decreased urinary stream, call a pediatric urologist immediately.

• #38 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  Currently, there are no defined guidelines for recommending androgen use, nor a defined regimen. […] Surgical intervention for hypospadias can be performed at any age, however, most authors recommend operative intervention at 6-18 months. […] The operative steps of hypospadias surgery involve penile degloving, correction of VC (orthoplasty), reconstruction of the urethra (urethroplasty), providing a vascularized coverage for the urethroplasty, reconstruction of the glans (glansplasty), and finally a cosmetic skin coverage to create a circumcised penile appearance. […] Correction of VC is a key component of hypospadias surgery to achieve a straight penis, while preserving penile length and erectile function. […] There are multiple surgical options and several proposed algorithms to guide urethroplasty decision-making.

• #39 Hypospadias | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypospadias

  In hypospadias, the urethral opening can be located at any point along the underside of the penis. The location of the opening determines the severity of the condition: […] Hypospadias can only rarely be seen on fetal ultrasound, so doctors typically diagnose it just after the baby is born, during his first physical examination. […] Upon diagnosing hypospadias, your doctor should refer your son to a pediatric urologic surgeon. […] Surgery remains the best and only way to correct all but the mildest cases of hypospadias. […] A pediatric urologic surgeon can perform the procedure, ideally when your son is between 6 to 12 months old.

• #40 Hypospadias – Wikipedia

  https://en.wikipedia.org/wiki/Hypospadias

  Surgery is not always required for minor hypospadias like glanular hypospadias and coronal hypospadias if the meatus is of good caliber, urine flow is in good stream forwardly directed. […] Many techniques have been used during the past 100 years to extend the urinary channel to the desired location. Today, the most common operation, known as the tubularized incised plate or „TIP” repair, rolls the urethral plate from the low meatus to the end of the glans. […] Most distal and many proximal hypospadias are corrected in a single operation. However, those with the most severe condition having a urinary opening in the scrotum and downward bending of the penis are often corrected in a two-stage operation. […] Complications are usually corrected with another operation, most often delayed for at least six months after the last surgery to allow the tissues to heal sufficiently before attempting another repair.

• #41 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The outcomes of distal hypospadias repair are favourable, with a low incidence of redo surgery, but complications are encountered in 5-10% cases. […] Complication rates for proximal hypospadias with severe curvature show a high and variable complication rate of 15-56%. […] Postoperative complications can usually be identified early on in the first few months after surgery in most cases, but long-term followup is mandatory because delayed presentation with a urethral fistula and recurrent curvature of the penis following puberty spurt have been documented. […] The management of hypospadias repair complications are performed after a period of healing over 4-6 months, with the exception of urethral or meatal stenosis, which require more emergent attention. […] The majority of hypospadias outcome papers focus on surgical complications and there are few publications assessing long-term functional outcomes.

• #42 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  A recent systematic review of the long-term functional outcomes following hypospadias repair demonstrated that patient reported urinary symptoms, such as obstructive voiding, spraying, and deviated stream, more often than controls. […] Long-term sexual issues, such as erectile dysfunction, ejaculatory difficulties, lower self-esteem, teasing, and negative genital perception, have been reported in patients with hypospadias. […] Modern surgical techniques have significantly reduced complication rates, but standardization of reporting and well-designed prospective studies will further aid surgical decision-making.

• #43 Hypospadias in Children: Diagnosis and Treatment

  https://www.massgeneral.org/children/hypospadias/diagnosis-and-treatment

  If the hypospadias is severe, doctors may diagnose it prenatally (before birth) through an ultrasound. However, it is more common for a family member or doctor to notice the condition after your baby is born. This is because the penis may look unusual. A pediatric urologist or pediatric surgeon can diagnosis hypospadias with a physical examination. […] Hypospadias surgery is best performed between 6 months of age and 3 years of age (before your child is toilet trained). This is when the risks of psychologically stressing your child and of using general anesthesia are both low. […] While boys rarely experience complications following hypospadias surgery, problems are more likely to happen following a proximal hypospadias correction. Infection and bleeding are rare, and the most common problem following surgery is a hole (fistula) that forms in another place on the penis. Additionally, scars may form in the urethra that could interfere with urination. If your child experiences urine leaking from a second hole or a decreased urinary stream, call a pediatric urologist immediately.

• #44 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  The outcomes of distal hypospadias repair are favourable, with a low incidence of redo surgery, but complications are encountered in 5-10% cases. […] Complication rates for proximal hypospadias with severe curvature show a high and variable complication rate of 15-56%. […] Postoperative complications can usually be identified early on in the first few months after surgery in most cases, but long-term followup is mandatory because delayed presentation with a urethral fistula and recurrent curvature of the penis following puberty spurt have been documented. […] The management of hypospadias repair complications are performed after a period of healing over 4-6 months, with the exception of urethral or meatal stenosis, which require more emergent attention. […] The majority of hypospadias outcome papers focus on surgical complications and there are few publications assessing long-term functional outcomes.

• #45 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  A recent systematic review of the long-term functional outcomes following hypospadias repair demonstrated that patient reported urinary symptoms, such as obstructive voiding, spraying, and deviated stream, more often than controls. […] Long-term sexual issues, such as erectile dysfunction, ejaculatory difficulties, lower self-esteem, teasing, and negative genital perception, have been reported in patients with hypospadias. […] Modern surgical techniques have significantly reduced complication rates, but standardization of reporting and well-designed prospective studies will further aid surgical decision-making.

• #46 Molecular diagnosis in hypospadias | Urología Colombiana

  https://www.elsevier.es/es-revista-urologia-colombiana-398-articulo-molecular-diagnosis-in-hypospadias-S0120789X17300849

  Molecular diagnosis in hypospadias […] The aim of this study is to perform a systematic review of the principal genetic and molecular diagnostic methods for hypospadias and their usefulness. […] Hypospadias are the birth defect of the ventral aspect of the penis, accompanied by an ectopic location of the urethral meatus. […] Within the genetic and molecular test available for diagnosis, many are of varying usefulness. These include, among others, karyotyping, FISH, and Sanger sequencing. […] Due to advances in technology, there are multiple molecular diagnosis methods that can widen the knowledge of the etiology of hypospadias. They also allow them to be used in the everyday practice for a complete study of patients. […] Karyotyping: It should be used as an initial diagnostic approach in any patient presenting with syndromic or non-syndromic hypospadias.

• #47 Molecular diagnosis in hypospadias | Urología Colombiana

  https://www.elsevier.es/es-revista-urologia-colombiana-398-articulo-molecular-diagnosis-in-hypospadias-S0120789X17300849

  Fluorescence in situ hybridization (FISH): It detects nucleotide sequences in cells or tissues. […] Comparative genomic hybridization (CGH): It allows the detection of amplifications and deletions in the smallest chromosomal regions. […] DNA sequencing (Sanger method) or the chain termination method: It is based on the use of DNA polymerase to synthesize DNA strands that have a specific termination. […] Direct sequencing of exons that encode genes involved in hypospadias has been used in multiple studies to identify different mutations. […] Whole exome sequencing (WES): This technique has allowed the identification of deletions in cases of gonadal dysgenesis and disorders of sex development that include hypospadias as one of their manifestations. […] Genome-wide association study (GWAS): This diagnostic method is useful to identify the loci that can be etiological. […] There are different genes involved and identified as causing syndromic and non-syndromic hypospadias. […] To complement the study of patients with this pathology, it is advisable to start with karyotyping as an initial diagnostic approach, essential in patients with disorders of sex development.

• #48 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypospadias.aspx

  The successful outcome of surgery can be expected within six months. […] Although there are up-to-date technologies for treating children with hypospadias, many researchers are developing clinical trials that provide great success in the diagnosis and treatment of this deformity. Clinical trials include research on hypospadias genetics to know about the cause and to help in identifying the malformation at the early stage. Various developing techniques have led to a high success rate for treatment of hypospadias.

• #49 Hypospadias: Pathogenesis, diagnosis, and evaluation – UpToDate

  https://www.uptodate.com/contents/hypospadias-pathogenesis-diagnosis-and-evaluation

  Hypospadias is a congenital anomaly of the male urethra, foreskin, and penis that results in abnormal ventral placement of the urethral opening. The pathogenesis, diagnosis, and evaluation of hypospadias will be reviewed here. […] The diagnosis of hypospadias is based on the physical examination and the location of the urethral meatus.

• #50 Proximal Hypospadias: More Than Meets the Eye? – American Urological Association

  https://auanews.net/issues/articles/2022/january-2022/proximal-hypospadias-more-than-meets-the-eye

  Taken together, given high rates of DSD and genetic conditions in boys with proximal hypospadias, we recommend at minimum a karyotype in the initial diagnostic approach for these patients. It is prudent to pursue further genetic and endocrine evaluation in the setting of concomitant undescended testicle(s) or in the presence of multiple congenital anomalies. Further testing should be considered if scrotal abnormalities (eg bifid, penoscrotal transposition) are present. […] When evaluated with genetic and endocrine testing, many boys with proximal hypospadias are found to have DSD and other systemic genetic conditions that affect future care and prognosis. All boys with proximal hypospadias should have a karyotype. Further genetic and endocrine testing should be considered for boys with proximal hypospadias and undescended testes, multiple congenital anomalies, scrotal abnormalities, and families who desire more information.

• #51 Hypospadias: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15060-hypospadias

  Hypospadias is a congenital condition in which the meatus isnt at the tip of the penis. A provider can diagnose it shortly after birth. Hypospadias usually requires surgery. […] Healthcare providers usually diagnose hypospadias shortly after birth. Checking for hypospadias is part of the routine newborn physical examination that a pediatrician performs. […] If a pediatrician detects hypospadias, theyll refer you to a pediatric urologist. A pediatric urologist is a doctor who specializes in diagnosing and treating conditions that affect the urinary and reproductive systems in children. […] Surgery (hypospadias repair) can treat hypospadias. Most pediatric urologists will perform a hypospadias repair when your child is between 6 and 12 months old. […] The outlook for hypospadias is good. Hypospadias repair has a high success rate. The goal of successful surgery is to create a penis that appears and functions normally.

• #52 Hypospadias | Department of Urology

  https://www.med.unc.edu/urology/pediatrics/pediatric-conditions/hypospadias/

  Typically, infants are diagnosed with hypospadias soon after birth. […] If your child is diagnosed with hypospadias, a circumcision should not be performed because the foreskin tissue may be needed for repair. […] Sometimes, mild hypospadias may be overlooked. Occasionally, it is possible for a boy to have a normal foreskin that covers the hypospadias. If this occurs, hypospadias may be diagnosed after your child is circumcised. […] Surgery is required to reposition the urethral opening to the tip of the penis, if necessary straighten the shaft of the penis and correct or remove the dorsal hooded foreskin. […] In most cases, surgical repair results in a penis with a normal or near-normal function and appearance with no immediate or long-term problems.

• #53 Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5332236/

  A recent systematic review of the long-term functional outcomes following hypospadias repair demonstrated that patient reported urinary symptoms, such as obstructive voiding, spraying, and deviated stream, more often than controls. […] Long-term sexual issues, such as erectile dysfunction, ejaculatory difficulties, lower self-esteem, teasing, and negative genital perception, have been reported in patients with hypospadias. […] Modern surgical techniques have significantly reduced complication rates, but standardization of reporting and well-designed prospective studies will further aid surgical decision-making.

• #54 Hypospadias and small penis size

  https://www.hypospadiasfoundation.com/hypospadias-and-small-penis-size-diagnosis-and-treatment/

  Hypospadias is a congenital malformation affecting about 1 in 250 male births, this amounts to more than 50,000 children born in India every year with hypospadias. In this condition, the urethral opening lies on the underside of the penis instead of its tip. […] The relationship between isolated hypospadias and penile size is complex. Studies show the following: No significant difference in length: Research suggests that overall penile length in infants and prepubescent boys with isolated distal or minor hypospadias is comparable to unaffected boys in most boys. While the penis may be small in proximal or severe hypospadias. […] Some children with hypospadias may have hormonal issues like testosterone production defect, androgen insensitivity or 5 alpha reductase deficiency. Whenever we find penis size to be very small along with hypospadias, we typically do a detailed hormonal evaluation to find out the real cause and then treat it.

• #55 Hypospadias and small penis size

  https://www.hypospadiasfoundation.com/hypospadias-and-small-penis-size-diagnosis-and-treatment/

  First, penile size should be measured in all children with hypospadias. Two measurements are important penile length (stretched penile length) and glans diameter. […] If the penile size is very small in a full-term baby or the baby has severe hypospadias, then we do a full hormonal test battery consisting of LH, FSH, AMH, Testosterone and then give 3 doses of hCG hormone to stimulate the testis. […] All these tests and their interpretation should be done by an experienced pediatric urologist or a hypospadias surgeon or a pediatric endocrinologist.

Zobacz więcej